Anyone willing to chat about starting a private practice?

Started by Blackmateria
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Blackmateria

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I'm planning on starting a pain practice solo next year in the Midwest. I have a location in mind and am starting the credentialing/equipmemt purchasing process. This forum has been a big help, but if anyone is willing to chat over phone or text to bounce specific ideas off of, please DM me. These would be things like logo/should I offer this service/is this a good deal etc. My other pain doc friends are all in academics or HOPD, so any help would be appreciated.
 
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Lease your space, 5 exams and a procedure room is plenty for you and a future midlevel provider. Cheap but good c arm, Oakworks table, medline and Henry schein (pedes pal GPO) control your checkbook and credit card, get privileges at a big hospital nearby. They will put you on their website under affiliated providers. I got my first good referral source from an older doc my father in law did construction work for. I also had good luck with hospital based pcps at their further outlying clinics. Make sure your staff actually know how to do auths. I had a lady who said she did but really had very limited experience. She would have been a great MA but she presented herself as a MA who could also do auths and that ended her employment quickly.
 
Be willing to wear the black hat and do things the other pain clinic won’t at first as far as taking over difficult patients. I’m meaning in being the one to tell them “No, you can’t be on xyz, abc, and 123 every 4 hours the rest of your life.”
 
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BobBarker said:
Lease your space, 5 exams and a procedure room is plenty for you and a future midlevel provider. Cheap but good c arm, Oakworks table, medline and Henry schein (pedes pal GPO) control your checkbook and credit card, get privileges at a big hospital nearby. They will put you on their website under affiliated providers. I got my first good referral source from an older doc my father in law did construction work for. I also had good luck with hospital based pcps at their further outlying clinics. Make sure your staff actually know how to do auths. I had a lady who said she did but really had very limited experience. She would have been a great MA but she presented herself as a MA who could also do auths and that ended her employment quickly.
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How much square footage do you think that translates to comfortably, including procedure suite?
 
We have 8 rooms, a large procedure room, breakroom, a front office space that is too large and a larger office that is shared by the two doctors and the office manager and we are about 3500sq ft. I think you can do it well in 2500sq ft or a little over that.
 
BobBarker said:
We have 8 rooms, a large procedure room, breakroom, a front office space that is too large and a larger office that is shared by the two doctors and the office manager and we are about 3500sq ft. I think you can do it well in 2500sq ft or a little over that.
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A startup doc doesnt need more than 3 maybe 4 exam rooms and 2500 sq ft max. 2000-2200 is fine.

You need to keep expenses down. Sign a three to five year lease and move in a bigger space later.
 
It is going to be a 5 year lease minimum due to landlord buildout costs. We are trying to make this man some money. The best way is to stay in this space indefinitely with one doc and one excellent midlevel. Give up some costs on rent for two years but then don’t have to move once you get the midlevel. Don’t expand beyond that. Make life simple, safe, smooth.
 
mdo1738 said:
3 is enough in general for most docs. Can see 40 patients a day in 3 rooms.
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Thats about what I have now in my current W2 job. The space Im looking at is basically a room with no walls. Its 2200 sq ft charging 4500 in the Midwest. If anyone could share how much they put into their initial build out, let me know. They are covering HVAC and plumbing for one bathroom but ill have to cover the rest.
 
BobBarker said:
Lease your space, 5 exams and a procedure room is plenty for you and a future midlevel provider. Cheap but good c arm, Oakworks table, medline and Henry schein (pedes pal GPO) control your checkbook and credit card, get privileges at a big hospital nearby. They will put you on their website under affiliated providers. I got my first good referral source from an older doc my father in law did construction work for. I also had good luck with hospital based pcps at their further outlying clinics. Make sure your staff actually know how to do auths. I had a lady who said she did but really had very limited experience. She would have been a great MA but she presented herself as a MA who could also do auths and that ended her employment quickly.
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How do you get privileges at a big hospital nearby? Aren’t they incentivized to not give privileges to out-compete you? Would this be for larger cases/OR or do you mean so you can get linked into their system for referrals?
 
You can have the landlord cover the buildout and add it to your rent. I think many would do it for 0% interest over 5 years.

My space and my space I’m moving to were both realtors offices. The exam rooms were the realtors or staff offices. The procedure room would be the broker’s office or the conference room. They will have a break room and a public/private bathroom. The reception area will have to be expanded. They don’t ever have true waiting rooms. Usually, you would just have to bust into one realtors office to expand the waiting room sufficiently. They will have a small area for front desk staff most of the time. I would explore that. The market is bad and the big, vanity realtors offices are a thing of the past. I can’t remember the last time I have been in a realtors office as a client. Maybe never.
 
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We have two large non-profit systems that give everyone qualified privileges. You get your profile built into their EMR for easy referrals, you get full access to their emr, and you get a small profile on their website. You don’t have to do any cases even.
 
It is too cumbersome to log into their EMR so I don’t do that anymore but I did in the beginning. I don’t do cases at either anymore. But these are things that are helpful over the first couple years and help get your name out there. Also, find the best independent imaging center and get portal access. We have touchstone imaging and they are cheapest/best. They work on the weekend. Studies happen whenever the patient is available. I send them all of my patients.
 
Blackmateria said:
Thats about what I have now in my current W2 job. The space Im looking at is basically a room with no walls. Its 2200 sq ft charging 4500 in the Midwest. If anyone could share how much they put into their initial build out, let me know. They are covering HVAC and plumbing for one bathroom but ill have to cover the rest.
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Just over $20 per square foot sounds reasonable. In terms of buildout, its all negotiable. You will obviously get a lot more if you are starting from a shell.

In seller's markets you might only get carpet allowance. In buyer's markets or if the space has sat for awhile, you can get more build out.

If you are trying to keep costs down but you like the space, you can get landlord to amortized build out costs or get more costs for a longer lease.

Its all negotiable.
 
BobBarker said:
You can have the landlord cover the buildout and add it to your rent. I think many would do it for 0% interest over 5 years.

My space and my space I’m moving to were both realtors offices. The exam rooms were the realtors or staff offices. The procedure room would be the broker’s office or the conference room. They will have a break room and a public/private bathroom. The reception area will have to be expanded. They don’t ever have true waiting rooms. Usually, you would just have to bust into one realtors office to expand the waiting room sufficiently. They will have a small area for front desk staff most of the time. I would explore that. The market is bad and the big, vanity realtors offices are a thing of the past. I can’t remember the last time I have been in a realtors office as a client. Maybe never.
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converting realtor space is common
 
mille125 said:
converting realtor space is common
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Both of my offices were former financial spaces. Only had to modify a wall or two. That was cheap. When you get into plumbing it can add time or cost. But these commercial spaces are designed to add or remove walls easily
 
You are right. I couldn’t quite remember. My employees stared lower but it was a few years ago and they understood they were chilling a lot as the clinic was quiet.
 
BobBarker said:
It is going to be a 5 year lease minimum due to landlord buildout costs. We are trying to make this man some money. The best way is to stay in this space indefinitely with one doc and one excellent midlevel. Give up some costs on rent for two years but then don’t have to move once you get the midlevel. Don’t expand beyond that. Make life simple, safe, smooth.
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how much are you paying $/SQFT? NNN?
 
Status Sciaticus said:
how much are you paying $/SQFT? NNN?
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To rent in a decent location in my area has risen to 25-30 dollars per sq foot. Older or in less desirable areas can be 18-20. Most desirable are 35 dollars on up. This is midwest prices not the coasts or Hawaii.

NNN usually runs about 5-6 dollars a foot.
 
mille125 said:
To rent in a decent location in my area has risen to 25-30 dollars per sq foot. Older or in less desirable areas can be 18-20. Most desirable are 35 dollars on up. This is midwest prices not the coasts or Hawaii.

NNN usually runs about 5-6 dollars a foot.
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These are the rates I see now as well
 
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I wouldn’t worry so much about your rent and your total square footage, that will change overtime (small to larger space ). I’d focus on how you plan on marketing and competing with the hospitals for patients. What is the competitive climate where you’re starting your practice? Is it flooded with ACOs?
 
BobBarker said:
We have two large non-profit systems that give everyone qualified privileges. You get your profile built into their EMR for easy referrals, you get full access to their emr, and you get a small profile on their website. You don’t have to do any cases even.
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This may not be universally true, but my understanding is that hospitals can't block doctors from getting credentialed for anti-competitive reasons.

Also, at least one of the systems I got credentialed with had a minimum number of required cases within some period of time, like 2 years. I don't know what the consequence of failing to do this was, but you'd still get the benefits until then.
 
Google ads X3. Bring lunches to practices. Local doc meetings. Give presentations to wc or pi atty groups and medical societies. Join small biz groups.
 
nvrsumr said:
Google ads X3. Bring lunches to practices. Local doc meetings. Give presentations to wc or pi atty groups and medical societies. Join small biz groups.
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Great advice. I was debating about google ads but wasn’t sure if it would be a good return on investment. How much would you spend per month on it?

I’ve done some lunches but haven’t seen any referrals come from them yet. It is a new practice I opened less than 2 months ago so still very new so I’m trying to be patient
 
The new world is to get noticed by AI. Online presence and interaction answering questions that are asked is the new SEO. Think like a patient typing a question into AI. If you are on socials posting about that issue and/or your website addresses it, you will start to be noticed and referenced in responses.
 
cowboydoc said:
The new world is to get noticed by AI. Online presence and interaction answering questions that are asked is the new SEO. Think like a patient typing a question into AI. If you are on socials posting about that issue and/or your website addresses it, you will start to be noticed and referenced in responses.
Click to expand...
This is definitely more important now. I started up a new facebook/instagram campaign at the suggestion of my marketer. Even at modest budget it has produced 5-6 good referrals in the first three weeks.
 
I hired a company to do some Google ad work. Asked about doing some fb marketing as well but they really wanted me to make TikTok’s for it and I’m just not that motivated
 
mille125 said:
This is definitely more important now. I started up a new facebook/instagram campaign at the suggestion of my marketer. Even at modest budget it has produced 5-6 good referrals in the first three weeks.
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Everyone does what suits there needs and talents. I am just telling you that I launch a moderate to low budget facebook/instagram campaign and I now have 9 referrals in 3.5 weeks (and only 1 of the 9 was seeking meds). Two of them just posted this weekend.

Surprised by the results and again I am spending a low/moderate budget compared to some.
 
mille125 said:
Everyone does what suits there needs and talents. I am just telling you that I launch a moderate to low budget facebook/instagram campaign and I now have 9 referrals in 3.5 weeks (and only 1 of the 9 was seeking meds). Two of them just posted this weekend.

Surprised by the results and again I am spending a low/moderate budget compared to some.
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Whats your ballpark spend if you feel comfortable sharing?
 
mille125 said:
Everyone does what suits there needs and talents. I am just telling you that I launch a moderate to low budget facebook/instagram campaign and I now have 9 referrals in 3.5 weeks (and only 1 of the 9 was seeking meds). Two of them just posted this weekend.

Surprised by the results and again I am spending a low/moderate budget compared to some.
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I think with all the cash pay services you do it makes a lot of sense. You need to filter for people who are willing to pay more to get a more “premium” experience. For bread and butter pain in an underserved area I get 95% of my patients from PCP and surgeon referrals. It took about 6-12 months for word to get around that I wasn’t doing any opioid management. We’ve done Facebook ad campaigns before and they were a waste.
 
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JFS said:
Whats your ballpark spend if you feel comfortable sharing?
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Everybody that I talked to that really got some good leads spent $3000 per month on just ads

I was brought in kicking and screaming by my marketer. Already spend $500 on google ads and $850 on website. I gave them $800 budget and I have been surprised, I must admit. There was no one more skeptical than me.
 
callmeanesthesia said:
I think with all the cash pay services you do it makes a lot of sense. You need to filter for people who are willing to pay more to get a more “premium” experience. For bread and butter pain in an underserved area I get 95% of my patients from PCP and surgeon referrals. It took about 6-12 months for word to get around that I wasn’t doing any opioid management. We’ve done Facebook ad campaigns before and they were a waste.
Click to expand...
I thought that I would say that I was wasting my money but it has not been that way. I used to be 95% referrals too which is why I was opposed for so many years.
 
mille125 said:
Everybody that I talked to that really got some good leads spent $3000 per month on just ads

I was brought in kicking and screaming by my marketer. Already spend $500 on google ads and $850 on website. I gave them $800 budget and I have been surprised, I must admit. There was no one more skeptical than me.
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I’m not sure if I can afford these costs since I’m not bringing much at all in right now. It’s so painful paying rent and payroll with no income for myself right now lol

Can anyone speak to what is an expected growth trajectory month by month so I can see if I’m keeping pace or need to change things up?
 
sbp111 said:
I’m not sure if I can afford these costs since I’m not bringing much at all in right now. It’s so painful paying rent and payroll with no income for myself right now lol

Can anyone speak to what is an expected growth trajectory month by month so I can see if I’m keeping pace or need to change things up?
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How long you been at it?
 
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